Peterman S B
Radiologic Health Services Research Program, Emory University School of Medicine, Atlanta, GA 30322, USA.
Radiology. 1996 Sep;200(3):771-8. doi: 10.1148/radiology.200.3.8756930.
To compare the postdural puncture headache (PDPH) rates after myelography with use of 22-gauge Whitacre (blunt tip) versus standard 22-gauge Quincke (bevel-tip) spinal needles.
At myelography, 340 patients were randomly assigned to one of two groups in which either the Whitacre (167 patients) or the Quincke (173 patients) needle was used. Follow-up was at 48 hours and at 4 days after the procedure. Crude and adjusted Whitacre/PDPH odds ratios and risk ratios were calculated.
The crude Whitacre needle PDPH risk was 9.6%, and the crude Quincke needle PDPH risk was 15.6%. The absolute risk difference was 6.0% with a 95% confidence interval of -0.98% and 13.04%. The adjusted Whitacre/PDPH odds ratio was 0.492 with a 95% confidence interval of 0.241 and 1.003. The Whitacre needle group had a statistically significantly lower PDPH severity grade (P = .0151), similar PDPH duration, and more technical difficulty with the needle.
The Whitacre needle is associated with an equal or lower PDPH risk; the lack of statistical significance is most likely related to sample size. Further study is necessary to determine whether the decreased PDPH rate justifies the added difficulty associated with use of the Whitacre needle.
比较使用22号惠塔克（钝头）与标准22号昆克（斜面尖端）脊髓穿刺针进行脊髓造影后发生硬膜穿刺后头痛（PDPH）的发生率。
在脊髓造影时，340例患者被随机分为两组，分别使用惠塔克针（167例患者）或昆克针（173例患者）。在操作后48小时和4天进行随访。计算了未调整及调整后的惠塔克针/PDPH优势比和风险比。
未调整的惠塔克针发生PDPH的风险为9.6%，未调整的昆克针发生PDPH的风险为15.6%。绝对风险差异为6.0%，95%置信区间为-0.98%至13.04%。调整后的惠塔克针/PDPH优势比为0.492，95%置信区间为0.241至1.003。惠塔克针组的PDPH严重程度分级在统计学上显著较低（P = 0.0151），PDPH持续时间相似，且使用该针的技术难度更大。
惠塔克针与PDPH风险相等或更低相关；缺乏统计学显著性很可能与样本量有关。有必要进一步研究以确定PDPH发生率的降低是否能证明使用惠塔克针所增加的难度是合理的。
